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Keywords:

  • asthma management;
  • barriers;
  • community pharmacy;
  • perceptions;
  • pharmacist's role

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Declarations
  9. References

Objectives  Few studies have explored pharmacists' perceptions of their potential role in asthma management. This study aimed to investigate community pharmacists' perceptions of their role in the provision of asthma care, to compare the perceptions of metropolitan and regional pharmacists with regards to their role, to identify barriers to the provision of asthma management services and to explore their level of inter-professional contact.

Methods  A 29-item questionnaire was mailed to a convenience sample of community pharmacists. Items included pharmacists' perceptions of their role in asthma management, barriers to pharmacy asthma services and inter-professional contact. The setting was community pharmacies in metropolitan and rural New South Wales, Australia.

Key findings  Seventy-five pharmacists (63% male, 69% in metropolitan pharmacies) returned completed questionnaires (response rate 89%). Pharmacists perceived their role in asthma management along three major dimensions: ‘patient self-management’, ‘medication use’ and ‘asthma control’. Regional pharmacists described a broader role than metropolitan pharmacists. Most participants perceived time and patient-related factors to be the main barriers to optimal asthma care with pharmacist's lack of confidence and skills in various aspects of asthma care less important barriers. Almost 70% indicated that they would like more inter-professional contact regarding the care of patients with asthma.

Conclusions  Community pharmacists perceived a three-dimensional role in asthma care with regional pharmacists more likely to embrace a broader role in asthma management compared to metropolitan pharmacists. Pharmacists identified time and patient-related factors as the major barriers to the provision of asthma services. Future research should explore barriers and facilitators to expansion of the pharmacist's role in asthma management in a holistic way.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Declarations
  9. References

Healthcare is an evolving arena in which increased levels of consumer involvement and expectation, government, changing patient demography and technology are the main drivers of change.[1] In chronic disease states there has been a shift towards greater involvement and collaboration of allied health professionals in the community setting for more comprehensive disease management, improved patient outcomes and satisfaction as well as cost savings.[2]

Asthma is a typical example of a chronic disease state in which community pharmacists have been actively engaging in a range of disease and patient-centred management services for adults, resulting in improved asthma outcomes and reductions in healthcare costs. These services range from patient education and counselling,[3–5] medication management and review,[6–9] disease monitoring,[3,10,11] health promotion,[12] self-management education,[13–15] pharmaceutical care[16–20] and disease-state management.[11,21–24]

Community pharmacy provides a strategic venue for the provision of ongoing asthma care services. In Australia, over 86% of the 4926 approved community pharmacies are accredited under the Quality Care Pharmacy Program (QCPP), a quality-assurance programme dedicated to raising the standards of pharmacy services provided to the public. In New South Wales (NSW), 1667 (95%) of the state's 1761 pharmacies currently hold QCPP accreditation,[25] and are located in various geographical areas including metropolitan, inner and outer regional, remote and very remote, based on the physical road distance from a locality to the nearest urban centre.

When it comes to the delivery of asthma disease-state management services, it is appropriate that pharmacists undergo specialised training and are recognised as experts in asthma. However, under the broad umbrella of asthma management, there is a wide range of specific interventions that pharmacists can deliver as part of routine practice, without necessarily delivering a comprehensive and/or structured disease-state management service. While current national[26] and international[27,28] asthma guidelines endorse increased pharmacist involvement in asthma care, they do not articulate the specific role of the pharmacist and the activities that might be considered standard or even minimal in asthma management. Although there may also be a broad range of pharmacists' attitudes and perceptions associated with the provision of these interventions, few studies have explored pharmacists' perceptions of their potential role in asthma management.

Therefore, the aims of this study were to investigate community pharmacists' perceptions of their role in the provision of asthma care, to compare the perceptions of metropolitan and regional pharmacists with regards to their role and their relationships to other health professionals involved in management of patients with asthma and to identify barriers to the provision of asthma management services.

Methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Declarations
  9. References

This study was approved by the Human Research Ethics Committee, University of Sydney, NSW, Australia, and all participants signed informed consent prior to enrolment in the study.

Participants

Community pharmacists from metropolitan and regional areas of NSW, Australia, were recruited through a computer-generated random list of QCPP-accredited pharmacies in NSW to participate in an asthma research project entitled the New South Wales Asthma Survey. Their involvement in this project was minimal and required pharmacists to distribute surveys to people with asthma. The sampling frame for the present study was all pharmacists participating in the New South Wales Asthma Survey. Those who agreed to participate were posted a Pharmacist's Role in Asthma Management questionnaire and reply-paid envelope.

Pharmacist's role in asthma management questionnaire

A self-administered 29-item questionnaire comprising four sections was developed based on a literature review, current national asthma guidelines[26] and the research experience of the investigators (Table 1). As the guidelines do not articulate the specific elements of pharmacist delivered asthma interventions, the guidelines were used to identify all the potential activities/aspects of asthma management in which the pharmacist could engage or participate.

Table 1.  The 29-item Pharmacist's Role in Asthma Management questionnaire
Section 1 (role): please indicate your level of agreement with each of the following statementsa
The role of the pharmacist should include counselling patients about:
 1. frequency of reliever (blue) inhaler use.
 2. overuse of reliever (blue) medication.
 3. poor adherence with preventer medication.
 4. inhaler technique when first prescribed the inhaler.
 5. inhaler technique on a regular basis.
 6. trigger factors and avoidance strategies.
 7. patient's current level of asthma control.
 8. action plan ownership.
 9. patient self-monitoring of asthma control (by symptoms or peak flow measurements).
10. asthma self-management by the patient (i.e. recognising when and knowing how to take action when asthma gets worse).
Section 2 (barriers): please indicate to what extent you feel each of the following factors impact on the pharmacist's ability to provide specific asthma counselling or servicesb
11. Lack of time by the pharmacist
12. Lack of time by the patient
13. Pharmacists' perception that it is not their role
14. Patient's perception that it is not the pharmacist's role
15. Language barriers
16. Patient's health beliefs
17. Patient's lack of asthma knowledge
18. Patient perception that they are already well cared for by the doctor
19. Conflict between professional and commercial interests
20. Trying not to ‘overstep’ the role of the doctor
21. No financial incentive
Lack of confidence or skills in:
22. asthma medication counselling
23. asthma adherence counselling
24. asthma self-management counselling
25. asthma trigger factor counselling
26. reviewing and counselling about asthma control
27. asthma monitoring
Section 3 (inter-professional contact): please indicate your level of agreement with each of the following statementsa
  • a

    Five-point Likert scale: 0 = strongly disagree to 4 = strongly agree.

  • b

    Five-point Likert scale: 0 = no impact to 4 = high impact.

28. I have good interprofessional contact with other healthcare professionals with regards to care of my patients with asthma.
29. I would like to have more contact with other healthcare professionals with regards to the care of my patients with asthma.

Section 1 (role) covered pharmacists' perceptions of their role in asthma management (items 1–10), with responses on a five-point Likert scale (0 = strongly disagree and 4 = strongly agree). Positive agreement to each item was indicated by a rating of 3 or 4. Section 2 (barriers) looked at pharmacists' perceptions regarding barriers to the provision of pharmacy asthma management services (items 11–27); respondents were asked to indicate the extent to which each item impacts on their ability to provide specific asthma counselling or services using a five-point Likert scale (0 = no impact to 4 = high impact). Section 3 (inter-professional contact) covered perceptions regarding inter-professional contact (items 28 and 29), with responses on a five-point Likert scale (0 = strongly disagree and 4 = strongly agree). Positive agreement to each item was indicated by a rating of 3 or 4. Section 4 (demographics) contained eight questions covering demographics: gender, age group, number of years since registration, position in the pharmacy, hours worked in the pharmacy/week, accreditation for Home Medicines Review (HMR),[29] pharmacy location and postcode. Pharmacies were classified as metropolitan or regional based on the pharmacy postcode.[30]

Data analysis

All data collected were de-identified and double-entered to ensure accuracy.

Section 1 (role)

Exploratory factor analysis was used to explore the linear relationships amongst the 10 items and the possibility of grouping related items together into a smaller number of factors.[31] Principal components analysis with varimax rotation was used to examine the factor structure. Factorability of the data set was assessed by the Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy (index >0.6). Factor extraction was based on eigenvalues, the scree plot and the proportion of total variance explained. Items that had poor factor loadings (<0.55) or cross loaded on two or more factors were removed. Internal consistency of the derived subscales was assessed by determining Cronbach's alpha coefficient (values >0.70 were sought).[32] Mean level of agreement scores to each factor for metropolitan versus regional pharmacists were compared using Mann–Whitney U tests. The proportion of pharmacists indicating a positive agreement to each individual item (i.e. a rating ≥3 on a five-point Likert scale from 0–4), each factor and all items was also calculated.

Section 2 (barriers)

Results were expressed as the proportion of pharmacists who rated any level of impact (i.e. rating 1–4 on a five-point Likert scale) to each item. Mean ratings indicating the extent of impact on service provision for each item were calculated and compared for metropolitan versus regional pharmacists using Mann–Whitney U tests.

Section 3 (inter-professional contact)

For each individual item (items 28 and 29), the proportion of community pharmacists indicating a positive agreement (i.e. a rating ≥3 on a five-point Likert scale) was calculated. Mean ratings indicating the level of agreement on each item were calculated and compared for metropolitan versus regional pharmacists using Mann–Whitney U tests.

Section 4 (demographics)

Descriptive analyses and comparisons between metropolitan versus regional pharmacists were undertaken using chi-square tests for categorical and Mann–Whitney U tests for continuous variables. A two-tailed, 5% (0.05) level of significance was used for all statistical procedures.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Declarations
  9. References

Eighty-four pharmacists were enrolled in the New South Wales Asthma Survey project and, of those, 75 (response rate 89%) returned the Pharmacist's Role in Asthma Management questionnaire.

Demographics

Fifty-two (69%) metropolitan and 23 (31%) regional (inner 23%; outer 8%) community pharmacists (63% male, 57% aged ≥40 years) participated in this study. The demographic characteristics of the respondents are summarised in Table 2. Metropolitan pharmacists worked significantly longer hours than regional pharmacists (Table 2).

Table 2.  Demographic characteristics of respondents
VariableMetropolitand pharmacists (%) (n = 52)Regionald pharmacists (%) (n = 23)P value
  • Our study: 69% work in metropolitan areas; 63% male; 62% sole proprietor; average work hours per week: males 45 h, females 37 h. National survey: 67% work in metropolitan areas; 59% male; 60% sole/partner proprietor; average work hours per week: males 43 h, females 35 h.[33]

  • a

    Chi-square test used.

  • b 

    Mann–Whitney U test used.

  • c

    Accreditation to be able to conduct a review of patient's medication in the community setting.

  • d 

    Classified according to the Australian Standard Geographical Classification (ASGC) system.[30]

GenderMale36 (69%)11 (48%)0.13a
Female16 (31%)12 (52%)
Age group20–39 years25 (48%)7 (30%)0.24a
≥40 years27(52%)16 (70%)
Position in the pharmacySole/partner proprietor31 (60%)15 (65%)0.51a
Employee pharmacist11 (21%)6 (26%)
Salaried manager10 (19%)2 (9%)
Accredited for Home Medicines ReviewcYes21 (40%)9 (39%)0.92a
No31 (60%)14 (61%)
Pharmacy locationMedical centre/mall13 (25%)6 (26%)0.92a
Local shopping area39 (75%)17 (74%)
Median number of years since registration13 (range 4–30)21 (range 7–31)0.33b
Mean (±SD) hours worked/week in pharmacy45 (±11.1)38.4 (±12.1)0.03b

Pharmacists' perceptions of their role in asthma management

For the 10 items in Section 1, examination of the correlation matrix revealed that all correlations were significant at the 0.01 level (correlations >0.30), and the KMO measure of sampling adequacy index was 0.83. Exploratory factor analysis, using principal components analysis with varimax rotation, yielded three primary factors with eigenvalues greater than unity, accounting for 66% of the total variance (Table 3).

Table 3.  Principal component estimates of the factor loadings for the 10 items relating to the pharmacist's role in asthma management (n = 75)
The role of the pharmacist should include counselling about …Factor loadingaEigenvaluesTotal variance
  • a

    Varimax rotation used.

Factor 1 (patient self-management) 4.1942%
 Action plan ownership (item 8)0.73  
 Patient self-monitoring of asthma control (item 9)0.86  
 Asthma self-management by the patient (item 10)0.72  
Factor 2 (medication use) 1.2813%
 Frequency of reliever inhaler use (item 1)0.77  
 Overuse of reliever medication (item 2)0.79  
 Poor adherence with preventer medication (item 3)0.59  
 Inhaler technique when first prescribed inhaler (item 4)0.60  
Factor 3 (asthma control) 1.1011%
 Inhaler technique on a regular basis (item 5)0.64  
 Trigger factors and avoidance strategies (item 6)0.71  
 Patient's current level of asthma control (item 7)0.62  
 Cronbach's alpha coefficient for the 10-item scale = 0.84

Factor 1 accounted for 42% of the total variance and consisted of three items: counselling about action plan ownership, patient self-monitoring of asthma control (by symptoms or peak flow measurements) and asthma self-management by the patient. The three-item subscale returned an alpha coefficient of 0.78. Factor 2 accounted for 13% of the variance and consisted of four items: counselling about frequency of reliever inhaler use, overuse of reliever medication, poor adherence with preventer medication and initial inhaler technique. The four-item subscale returned an alpha coefficient of 0.72. Factor 3 accounted for 11% of the variance and comprised three items: counselling about inhaler technique on a regular basis, trigger factors and avoidance strategies, and patient's current level of asthma control. The three-item subscale returned an alpha coefficient of 0.69. The factors were labelled, ‘patient self-management’ (Factor 1), ‘medication use’ (Factor 2) and ‘asthma control’ (Factor 3). Reliability analysis of the overall 10-items returned a Cronbach's alpha coefficient of 0.84, indicating homogeneity of items and good internal consistency.[32]

Following identification of the three dimensions, ratings for items underlying each dimension were summed. For each dimension, each participant received a summed score. For Factor 1, participants scored between 0 and 12 (based on Factor 1 being determined by three items) and positive agreement was indicated by a score of 9 or more. For Factor 2, participants scored between 0 and 16 (based on Factor 2 being determined by four items) and positive agreement was indicated by a score of 12 or more. For Factor 3, positive agreement was indicated by a score of 9 or more as for Factor 1.

Table 4 summarises mean factor scores for the total sample as well as metropolitan and regional pharmacists. The difference in mean scores for Factors 1 and 2 between metropolitan and regional pharmacists was not statistically significant. However, there was a statistically significant difference in mean scores for Factor 3 between metropolitan and regional pharmacists (P = 0.02), indicating that regional pharmacists were more likely to see their role encompassing counselling about asthma control.

Table 4.  Mean scores for Factor 1, Factor 2 and Factor 3 for the total sample and for metropolitan and regional pharmacists
Factor evaluatedTotal sample pharmacists (n = 75)Metropolitan pharmacists (n = 52)Regional pharmacists (n = 23)P valueb
Mean scorea±SDMean scorea±SDMean scorea±SD
  • a

    Summed score.

  • b 

    Mann–Whitney U test used for comparisons between metropolitan and regional pharmacists.

Factor 1, 3 items (patient self-management)9.31.79.21.89.71.40.25
Factor 2, 4 items (medication use)14.61.614.41.715.01.40.08
Factor 3, 3 items (asthma control)9.01.48.81.29.51.50.02

Individual items were also analysed to identify those items most commonly perceived by pharmacists to be part of their role in asthma management. The proportion of pharmacists indicating agreement to each individual item, to each factor and all items relating to their role are shown in Table 5.

Table 5.  The proportion of pharmacists indicating agreement to each individual item (left), each factor and all items (right) relating to their role
% Agree to item (3 or 4 rating)a (n = 75)Section 1 items (role)% Agree to factor (n = 75)% Agree to all items (n = 75)
  • a 

    On a scale of 0–4, where 0 = strongly disagree, 1 = disagree, 2 = neutral, 3 = agree, 4 = strongly agree.

 93Asthma self-management by the patient (item 10)65Factor 148Factors 1 + 2 + 3
 87Patient self-monitoring of asthma control (item 9)
 71Action Plan ownership (item 8)
100Inhaler technique when first prescribed the inhaler (item 4)92Factor 2
 99Frequency of reliever (blue) inhaler use (item 1)
 97Poor adherence with preventer medication (item 3)
 96Overuse of reliever (blue) medication (item 2)
 93Trigger factors and avoidance strategies (item 6)60Factor 3
 89Patient's current level of asthma control (item 7)
 68Inhaler technique on a regular basis (item 5)

Barriers to the provision of specific asthma counselling or services

Of the 17 potential barriers presented to participants, each one was considered to have at least some impact by over half the participants (Table 6). The four major barriers identified by over 95% of pharmacists impacting on their ability to provide specific asthma services included pharmacist's lack of time and patients' perception that they are already well cared for by the doctor, lack of time and lack of asthma knowledge. Of the six most commonly identified barriers, five of them related to ‘patient factors’. Interestingly, lack of financial incentive (63%) and conflict between professional and commercial interests (59%) were not perceived by pharmacists as having a great impact on their ability to provide specific asthma services. There was no significant difference in mean ratings between metropolitan and regional pharmacists.

Table 6.  The proportion of pharmacists rating any level of impact for each barrier in hierarchical order (left) and mean ratings relating to the extent of impact of each barrier (right) (n = 75)
% Rating any level of impact (1–4 rating)aSection 2 (barriers)Extent of impact
MeanbSD
  • a 

    On a scale of 0–4, where 0 = no impact, 1 = slight, 2 = moderate, 3 = considerable and 4 = high impact.

  • b 

    Moderate–considerable impact indicated if the mean rating is between 2 and 3.

100Lack of time by the pharmacist2.80.9
100Lack of time by the patient2.51.0
 97Patient perception that they are already well cared for by the doctor2.51.1
 96Patient's lack of asthma knowledge2.31.0
 85Patient's health beliefs1.81.1
 84Patient's perception that it is not the pharmacist's role1.81.0
 77Language barriers1.51.2
 76Trying not to ‘overstep’ the role of the doctor1.41.1
 75Lack of confidence or skills in asthma self-management counselling1.41.2
 75Lack of confidence or skills in asthma monitoring1.41.2
 75Lack of confidence or skills in reviewing and counselling about asthma control1.31.1
 69Lack of confidence or skills in asthma trigger factor counselling1.31.1
 68Lack of confidence or skills in asthma adherence counselling1.31.2
 63No financial incentive1.31.2
 61Pharmacists's perception that it is not their role1.31.3
 59Conflict between professional and commercial interests1.11.2
 59Lack of confidence and skills in asthma medication counselling1.11.3

Pharmacist's perceived level of inter-professional contact

Overall, sixty-seven (69%) pharmacists agreed (57% agreed, 12% strongly agreed) that they had good inter-professional contact with other health professionals in the care of their patients with asthma (item 28) but 67 (69%) agreed (47% agreed, 22% strongly agreed) that they would like to have more such contact (item 29). There were no significant differences in the mean ratings between metropolitan versus regional pharmacists.

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Declarations
  9. References

Community pharmacists perceived their role in asthma management along three major dimensions: ‘patient self-management’, ‘medication use’ and ‘asthma control’, with regional pharmacists perceiving themselves to have a slightly broader role compared to metropolitan pharmacists. Participants perceived time and patient-related factors to be the main barriers to optimal asthma care delivery with pharmacist's lack of confidence and skills in various aspects of asthma care also commonly identified as barriers. Almost 70% desired greater inter-professional contact in the care of their patients with asthma.

The strengths of this study include the high response rate, the high internal consistency of responses, as indicated by the Cronbach's alpha coefficient, and the high factor loadings for each of the identified factors. The sample was representative based on current national labour force data[33] (Table 2), and the sample size was adequate for factor analysis and reliability analysis. The limitations of the study were associated with the convenience sampling method, and the lack of qualitative research in the development of the questionnaire, which was based on current asthma management guidelines, the literature and expert opinion.

Few published studies have explored pharmacists' perceptions of their role in asthma management. Research in this area has primarily focused on structured community pharmacy-based asthma programmes;[11,15,17,21–23] however, for the average community pharmacist, neither national[26] nor international[27,28] asthma management guidelines articulate the optimal scope of their role in asthma care. Therefore, exploring the pharmacists' own perceptions was considered important for future programme implementation and sustainability.

In so doing, this study showed that pharmacists viewed their role in asthma management along three broad areas, consistent with current asthma management approaches outlined in national[26] and international guidelines:[27,28] medication use, patient self-management and asthma control. While 92% of participants indicated that their role was associated with counselling about ‘medication use’, far fewer believed in a role associated with patient self-management and asthma control, and only 48% perceived an extended role encompassing all three areas of asthma management. These results are consistent with the more ‘recognised’ role of the pharmacist: that is, medication related in view of their therapeutic knowledge and expertise. Not surprisingly, regional pharmacists perceived a broader role for community pharmacists compared with their metropolitan counterparts. This could relate to the shortages of medical practitioners and large distances in regional areas necessitating all healthcare professionals to take on broader roles in healthcare.[34] This potentially suggests that regional pharmacists may present the ideal target group to implement new asthma management programmes in community pharmacy.

When it comes to embracing a broader perspective of their role, a comprehensive study in the UK indicated that community pharmacists believed it was essential to extend their role.[35] This was driven by a dissatisfaction of a role restricted to dispensing medications and satisfaction with taking on a more patient-centred approach. However, Edmund and Calnan[35] also identified that there was a dichotomous approach to this, with some pharmacists' embracing and others resisting an expansion in their role. It was suggested that the professional status of pharmacy versus medicine,[36] the shifting focus of healthcare and the concept of professional autonomy and integration[37] all impact on this perception.

In this study, pharmacists identified important barriers to asthma counselling as including the pharmacist's time, and patient factors relating to time, perceptions of receiving adequate care from their doctor, perceptions of a more restricted role of the pharmacist, health beliefs and lack of asthma knowledge. In fact, over 80% of pharmacists perceived that the above-mentioned were significant barriers to extension of their role in asthma counselling. In previous research focusing on structured community pharmacy-based asthma programmes, pharmacists have consistently identified their own time constraints, lack of education and remuneration as the greatest barriers to the provision of asthma services.[8,17,38,39] In contrast to this, participants in our study perceived the patient as posing a number of significant barriers to the provision of optimal asthma management, which is consistent with other qualitative research findings.[40,41] Hence, appropriate tools and strategies, pragmatic in busy retail pharmacies, will be needed to help overcome barriers, as well as training and support for pharmacists involved in future delivery of pharmacy-based asthma care.

This study also examined the expectations of pharmacists with regards to their inter-professional relationships, since national and international asthma management guidelines promote a team-based approach to asthma care. Although most pharmacists reported currently having contact with other health professionals about care of their patients with asthma, almost 70% wanted more such interactions. This has been suggested by others.[15] While the present study did not explore this issue further, the strength of the pharmacists' response to this question, combined with the strong identification of barriers relating to the perceived roles of doctor and pharmacist in asthma management, indicate that future work is needed in the area of inter-professional relationships for management of asthma using both qualitative and quantitative methods.

Conclusions

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Declarations
  9. References

In conclusion, the main contribution of this research is in understanding the perceptions that pharmacists have of their role in asthma management. Community pharmacists perceived a three-dimensional role in asthma care with regional pharmacists more likely to embrace a broader role in asthma management compared to metropolitan counterparts. Pharmacists identified time and patient-related factors as major barriers to the provision of asthma services. However, with the current international drive to manage chronic disease management in primary care, the evidence for benefit from broader pharmacy-based disease-state management services, and the trend towards collaborative initiatives between pharmacists and other healthcare professionals, future research should explore barriers and facilitators to expansion of the pharmacist's role in asthma management in a holistic way.

Declarations

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Declarations
  9. References

Conflict of interest

The Author(s) declare(s) that they have no conflicts of interest to disclose.

Funding

We acknowledge the Asthma Foundation of New South Wales for their financial support.

Acknowledgements

We thank all the community pharmacists who participated in this study and Biljana Cvetkovski and Sarah Newton-John for their assistance and support during the project. We also acknowledge the Woolcock Institute of Medical Research.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Declarations
  9. References
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